Anesthesia coding compliance

cingram

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Ok I need opinions from everyone. I do anesthesia coding and we had an issue come up. OP report states a hysterectomy abdominal approach. The CRNA wants the vaginal approach coded (00944) instead of abdominal (00840) because they are both the same units and I am coding for accuracy and using 00944 is not a compliance issue. What are your thoughts?
 

thomas7331

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Ok I need opinions from everyone. I do anesthesia coding and we had an issue come up. OP report states a hysterectomy abdominal approach. The CRNA wants the vaginal approach coded (00944) instead of abdominal (00840) because they are both the same units and I am coding for accuracy and using 00944 is not a compliance issue. What are your thoughts?
The fact that the units are the same does not make it acceptable to use an incorrect code - if you are knowingly submitting incorrect information that is not supported in documentation, you cannot say definitively that it is not a compliance issue because it is not possible to know how these codes will be ultimately be used by the payers. Although the reimbursement might be the same for the two codes, it could still potentially cause a financial error because different codes may have different coverage requirements, be in different benefit categories, or be reported differently for calculation of risk or morbidity. It is a risky practice to assume that incorrect coding is not a problem simply because the codes in question are of the same value.

What it the CRNA's rationale for wanting an incorrect code submitted? There is no valid reason I can think of for doing this. If the procedure was actually a vaginal approach, then the documentation should be corrected. If it is not, then the correct code should be used.
 
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kc16

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The fact that the units are the same does not make it acceptable to use an incorrect code - if you are knowingly submitting incorrect information that is not supported in documentation, you cannot say definitively that it is not a compliance issue because it is not possible to know how these codes will be ultimately be used by the payers. Although the reimbursement might be the same for the two codes, it could still potentially cause a financial error because different codes may have different coverage requirements, be in different benefit categories, or be reported differently for calculation of risk or morbidity. It is a risky practice to assume that incorrect coding is not a problem simply because the codes in question are of the same value.

What it the CRNA's rationale for wanting an incorrect code submitted? There is no valid reason I can think of for doing this. If the procedure was actually a vaginal approach, then the documentation should be corrected. If it is not, then the correct code should be used.
I agree. 00944 is not the correct code for abdominal approach. 00840 would be the correct ASA code for this and that's how I would bill it.
 

Davieda Skobel

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Absolutely do not change your coding unless the Surgeon is willing to correct his/her documentation.You have to bill what is documented. If its not documented it wasn't done. If the CRNA thinks it was documented incorrectly the he/she needs to address that with the surgeon.Coding and billing just to get paid is a huge No/No!
Follow your instincts!

Good Luck,
Davieda Skobel CLPN, CPC
Columbus Ohio

This is just my opinion.
 
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